Vertebral fractures and crush injuries

Vertebral crush fractures are common complications in patients with osteoporosis. Osteoporosis is a disease that affects bone mass and is associated with vitamin D and calcium deficiency, postmenopause, a sedentary lifestyle, smoking, and age over 60. Although osteoporosis is a painless disease, its complications can affect quality of life and increase mortality when severe.

Crush fractures of the spine should be diagnosed with imaging tests, the preferred method being a spinal MRI, which not only indicates the presence of a fracture but also allows us to determine whether it is recent. It can also be performed with a CT scan or conventional X-rays.

Crush fractures vary in severity, and depending on the loss of height, they may benefit from kyphoplasty or vertebroplasty. These percutaneous treatments involve correcting the vertebral body deformity with the placement of a special cement that quickly stabilizes the fracture and restores the treated vertebra to a solid and resilient state. Following percutaneous treatment, the patient is authorized to go home on the same day of the procedure. The use of a girdle or corset is recommended to reduce the acute swelling caused by the crush fracture for a few weeks.

In cases where the crush injury has been chronic and where an MRI of the spine does not reveal bone edema, the recommended treatment is usually conservative, unless there is instability of the spinal segment, a deviation from the spinal axis, or spinal cord or radicular compression, in which case surgical treatment should be appropriately assessed by a surgeon and team experienced in complex spines. In addition to comprehensive monitoring and having ruled out an underlying pathology other than osteoporosis, measures such as physical therapy, analgesia, preventive support treatment such as a lumbar support belt or corset, and recommendations to avoid high-impact physical activity are the treatments that have shown the greatest benefit.

Although in most cases medical treatment can be performed by specialties such as gynecology, rheumatology, and primary care physicians due to the diagnosis of osteoporosis, evaluation by a spine specialist is recommended to prevent fractures or assess imbalances in the spinal axis or its biomechanics.